Whiteheads are a combination of oils, sebum and cellular fragments that produce firm to hard plugs within hair follicles. They are closed from the skin’s surface by cellular debris at the follicle opening. Because they are closed and have no contact with oxygen, they do not oxidize or turn brown, as blackheads do. They form a light or yellow-white lump and are called milia (or milium, singular). When bacteria is added to these plugs, the condition can lead to acne, especially cystic acne (as shown below).

Whiteheads are promoted by excessive cellular exfoliation, which quickly clog or block the follicles. Some skin specialists believe individuals with frequent and multiple blackheads and whiteheads produce sebum that is drier than normal and conducive to forming firm plugs. Sebum contributes to skin oils and people with dry sebum may have dry skin. This may be especially true of people with chronic whiteheads, but it is also possible to have dry sebum with oily skin.

The sebaceous glands normally produce sebum with linoleic acid (omega 6), an essential fatty acid. This type of sebum has a liquid viscosity. It is calming to the skin and does not promote follicular irritation that leads to plugs. When linoleic acid is not available, the sebaceous glands produce sebum with oleic acid. This oleic form of sebum is irritating to the skin and promotes plugs. Oleic sebum is much firmer than linoleic sebum and is prone to producing hard plugs rather than flowing out of the follicle. This causes blackheads and whiteheads and both of these conditions may lead to acne infections.

Patients with large numbers of whiteheads may have an inability to digest or absorb linoleic acid, which leads to sebum produced with an oleic acid form of sebum.

To help with linoleic acid deficiency, purchase flax seed oil supplements in the 1,000mg size. Take one capsule daily as directed.Do NOT take the supplements if pregnant or nursing.The supplements take 2-3 weeks to have an effect and the sebaceous glands will begin producing the linoleum form of sebum.This will reduce the volume of new plugs but may not eliminate them altogether.The supplements usually resolve issues with dry skin and in general improve the appearance of the skin.Flax seed oil supplements will not dissolve pre-existing plugs but will work in conjunction with home care products.

– This information comes to you from BiON Research – I stock their products and they work well for me! To learn more about which products to use, their education page has helpful suggestions

I love this article and wanted to share with you – this is excellent information with scientific references…by Brian Goodwin

Every day we are discovering more about nutrition and the key role it plays in our skin’s overall health. Our skin is a direct reflection of our dietary choices, lifestyle habits and imbalances, as well as the skin care we are using on a daily basis. Too often, all types of acne are treated the same way—kill the bacteria with antibiotics, exfoliate the skin with potentially harsh treatments and dry out the sebaceous glands. However, are we reaching for the branches of the problem instead of getting to the root of acne’s causes?

When it comes to acne and our diet, it can be broken down into three primary influences: hormones, nutrient deficiencies and the microbiome. All of these are tightly interconnected, with each greatly influencing another. For example, diet and potential nutrient deficiencies can influence a human’s microbiome balance, which in turn can affect hormones. In the same paradigm, nutrient deficiencies can also determine if the human body is creating the hormones needed to regulate the skin’s key functions, including sebum production and the inflammatory response. The microbiome (or bacterial balance) can also affect how well the human body is absorbing the nutrients needed to have healthy, balanced skin.

1. HORMONES

Hormones, by definition, are “Chemical messengers that travel throughout the body coordinating complex processes like growth, metabolism and fertility. They can influence the function of the immune system, and even alter behavior. Before birth, they guide development of the brain and reproductive system.”1 In other words, hormones control virtually everything and our dietary choices can in influence them greatly.

Dihydrotestosterone (DHT) is a potentially negative type of androgen or testosterone-like hormone, with links to hair loss in men and women as well as acne. DHT can also increase sebum production and inflammation in the skin, leading to the creation of a blocked follicle which becomes a low oxygen, breeding ground for P. acnes bacteria. Once again, a lot of conventional treatments for acne reach for the branches of the problem rather than the root, as many dermatologists recommend antibiotics as a primary treatment to treat acne. This only wipes out the bacteria that can create breakouts, rather than treating a potential root cause—DHT.

There are some natural ways that our clients can block DHT, both topically and internally. A number of plants (pumpkin seeds, stinging nettle, peppermint leaf, green tea) are effective DHT blockers, but unfortunately this still doesn’t solve the problem if we are continuing to ingest and stimulate DHT through other sources. Dairy is often the missing link in solving this issue, as many of our clients with acne are dairy lovers.

Dairy. Arguably, the biggest culprit when it comes to diet-influencing hormones that can create acne is dairy. Dairy has a lot of things working against it when it comes to the overall health of skin. Specifically, dairy increases DHT. Dairy also naturally contains sugar and casein, a large molecule protein which many people find difficult to break down and digest. These factors can also in influence the formation of acne in the skin. There is no such thing as hormone-free dairy products. The labels with the wording “no hormones” in big, bold lettering can be misleading. This labeling only means that no hormones have been added, when in reality there are at least 60 hormones contained in a single glass of cow’s milk that occur innately. In the case of chronically and conventionally untreatable acne, it is important that skin care professionals continue to work as a team with dermatologists rather than fight them. A dermatologist can run the necessary blood tests to determine if DHT levels are imbalanced, as well as prescribe more powerful DHT blockers, if needed. Spironolactone and drospirenone are DHT blockers and anti-androgen medications that have been shown in clinical studies to be helpful in the treatment of acne.2

Sugar. Sugar has been a widely discussed topic in the esthetics forum when it comes to glycation and aging; however, sugar can be another power player in the process of skin breakouts. High glycemic foods cause a spike in insulin, a hormone that controls blood sugar levels. There is evidence that insulin also stimulates an enzyme called 5-alpha reductase,3 which is an enzyme that converts testosterone to the potentially harmful DHT, in turn causing increased breakouts and oil production. Sugar also increases insulin growth factor-1 (IFG-1),4 which is also a hormone that has been linked to acne and other diseases in multiple studies.5-6

2. INFLAMMATORY FOODS

Gut inflammation can lead to malabsorption of nutrients and a nutrient deficiency. Addressing gut inflammation in a way is easy—eliminate inflammatory foods. Inflammatory foods can include dairy, as discussed previously, as well as other animal proteins (red meat, chicken, turkey, pork). Another group of inflammatory foods are processed food and sugars, as well food allergens, such as gluten and dairy. Your clients can work with a gastrointestinal doctor or food allergy specialist to identify their specific allergens through allergen-specific IgE blood testing (previously referred to as RAST or ImmunoCap testing). This is the most accurate testing on the market and will help to identify potential food allergens playing a role in the inflammation of the skin and body.

Dairy. Casein is one of the primary proteins found in all animal sources of dairy, and a specific type of casein, alpha s1 casein, has been identified as a major allergen.7-8 Although both goat’s and sheep’s milk contain a similar type of casein, there is anecdotal evidence that replacing cow’s milk (and their by-products) with goat or sheep’s milk in the diet is a hypoallergenic option, with marked improvement in eczema, digestive disorders, asthma as well as other inflammatory conditions, including acne.9-10 With casein also being a large molecule protein that is difficult to digest, our bodies could potentially not break down this protein, destroying our gut lining and allowing these proteins to enter the blood stream. This can lead to more inflammation of the body as our immune system attacks these proteins.

Animal protein. Eliminating animal proteins (with the exception of wild-caught sh due to the healthy, anti-inflammatory fats they naturally contain) will go a long way toward lowering in inflammatory levels in the body. There are many clinical studies pointing to animal proteins being a serious culprit in negatively in influencing the inflammatory response of the body. All of the amino acids, nutrients and proteins found in meat can be obtained from plant-based, complete protein sources such as peas, black beans and hemp seeds.

3. PROBIOTICS AND PREBIOTICS

The most talked about topic in reference to our microbiome is probiotics. Probiotics are healthy types of bacteria that can be used externally to help bring back balance to the microbiome on our skin, as well as taken internally to bring back balance to the microbiome of our digestive tract. Many choices in our internal diet can affect the delicate balance of this healthy bacteria. Pesticides and antibiotics can destroy this delicate balance. While taking probiotics internally is important, perhaps the most overlooked topic when it comes to probiotics are prebiotics.

Prebiotics are fibers and carbohydrates that function as food for good bacteria, allowing them to proliferate and repoplate. Many Americans eat a low- fiber diet, and this doesn’t support our healthy bacterial balance. Foods such as seaweed,11 dandelion greens,12-13 Jerusalem artichokes,14 chicory root15 and flaxseeds16 all have studies showing that their prebiotic fiber content can help to repopulate the gut with healthy bacteria and have a multitude of health benefits, including better digestive health, boosting the immune system and reducing inflammation.

Why do we need probiotics when it comes to our skin’s health and acne? Probiotics regulate the immune system,17 an important part of how skin deals with potential bacterial infections and the body’s overall skin’s defense. Probiotics also play a role in our overall nutrient absorption, energy metabolism, immunity and intestinal barrier function.18 In other words, without a dense and vast variation of probiotic cultures in our digestive tract, we can’t absorb the nutrients we need from the food we eat. We also can’t fight infection, control inflammation or regulate our response to food allergens. This not only results in a decline in our overall health and ability for our cells to function optimally, but will also affect hormonal balance in the body and how our bodies deal with potential stressors.

Brian Goodwin is a licensed esthetician and an international educator for Éminence Organic Skin Care with over 10 years in the industry. He is also a master herbalist, a master esthetician and a consultant. Goodwin has educated over 2,000 spas all over the world.

DIETARY CHANGES FOR LESS ACNE

Eliminate dairy

Consume and apply plant-based DHT blockers

Try to steer clear of synthetic multivitamins

Megadose on superfoods to fill in the nutrient gaps, specifically focusing on fruits and vegetables high in fiber, zinc and antioxidants that support digestion, microbiome and hormonal balance to support our skin’s health

Eliminate inflammatory foods such animal proteins, and food allergens like gluten and dairy

Take probiotics

Feed probiotics with pre-biotic food so that they stay alive in the gut and repopulate. Some great sources of prebiotics are flaxseeds, Jerusalem artichokes, seaweed and dandelion greens

For more help in making dietary changes, you can work with a Certified Nutritionist. I recommend Nicole Bianchi NC in San Francisco – foodandhearth.com

I love this excellent article, written by Licensed Esthetician Danae Markland, so I wanted to share it with you…

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In their decades on the market, microbeads found their way into a wide variety of products, including toothpastes, and facial and body scrubs. Although gentle and effective mechanical exfoliants, the unintended consequence of their use has had a negative environmental impact.

Plastic microbeads do not biodegrade, and once they are washed down the drain, they go through our waste stream to end up in waterways. These small, spherical particles are the size of a grain of sand and cannot be filtered out of bodies of water.

Therefore, over years of use, microbeads have inundated waterways and are causing negative health issues for marine life and our aqueous ecosystems. Although we have become attached to these small particles in our products, have no fear, there are many effective alternatives.

Why Exfoliation is Necessary?

In a perfect world, our skin is a self-renewing organ. New cells are born at the basal layer and rise up through the epidermis, ultimately flattening and turning from keratinoctyes into corneocytes. Approximately every 28 days, these cornecytes go through a complex biochemical process called desquamation, which cleaves and sheds dead cells away from the stratum corneum, leaving a fresh and bright skin surface behind. Unfortun­ately, there are many roadblocks to this all-important process of desquamation. Even simple skin dehydration can impede normal cell turnover. Add stress, pollution, poor lifestyle choices (smoking, drinking), age, insufficient skin care habits and the result can be impacted, dull, rough and unhealthy-looking skin. The best way to overcome this is regular, gentle exfoliation. Healthy cell turnover can be achieved by either chemical or mechanical means. There are a variety of chemical exfoliation options that can be used in place of microbeads, while there are also numerous substances and techniques that can be used as microbead alternatives for mechanical exfoliation.

Mechanical Exfoliation

By definition, mechanical exfoliation is the process of physically scrubbing or removing any surface build-up of corneocytes, or dead skin cells. As more time goes by after the deadlines pass for the Microbead-free Waters Act (H.R. 1321)—which banned the manufacture of, formulation with and sale of products containing microbeads— there will certainly be many more options on the horizon. Below are some of the most common options.

Fruit pits, seeds and nut shells. When crushed, there are a number of stone fruit pits and nut shells that are good to use for body exfoliation. Although these particles can have jagged edges, they are good for ridding feet, elbows and thicker body skin of build up. They can be used in varying particle sizes in formulations, but even the fine particles from pits and shells can be too aggressive for delicate facial and décolleté skin. Some of the most commonly used sources for these particles are apricot pits and coconut or walnut shells. Other fruit seeds and fibers like those from raspberries, cranberries and blackberries can also be used, but are not as common in commercial products. Most of these can be ground into fine powders, making them less aggressive, yet are still best left for use on the body.

Beads and waxes. Hydrogenated beeswax and castor and jojoba waxes and oils can be used to create clear and odorless beads. They are gentle, yet some downsides are that they can darken with exposure to oxygen, making them not cosmetically elegant for some formulations. Additionally, they are large in size and can be difficult to use in some types of packaging.

Grain powders. Many beneficial grains can be ground into gentle exfoliative powders. Some of the most popular and effective are oats, rice and chickpeas. Oat flours and powders can be a good option for more sensitive skin due to the natural calming properties of Avena sativa (oat). Rice is an excellent choice, as the particles are gentle and effective for a wide range of skin types and conditions. Used for centuries in Asia for skin clearing, rice powders and flours contain a variety of vitamins and amino acids.

Salts and sugars. Even when milled to a small dimension, these particles are best for body use. Salts are well known for their high concentration of minerals that can be beneficial for dry skin conditions. Minerals such as magnesium, potassium, calcium and bromide are the most prevalent. The most common are Dead Sea, black Hawaiian sea, Himalayan and basic sea salt.

Sugars are also best for foot scrubs and body scrubs. Their natural humectant properties help to keep the skin moist after use. The natural sweet aroma can also be a draw for many looking for a more spa-type experience from their body scrub.

Because many of these materials have their own set of benefits, it is also a good option to look for products that contain a blend of several to maximize results.

Chemical Exfoliation

Although many incorrectly assume that the use of chemical exfoliants must be more aggressive than mechanical methods, this option can be an excellent way to keep skin healthy and radiant. This method covers a wide range of options. Deeper peels, such as 30%+ TCA solutions, are only used several times a year, while gentle, low-percentage Alpha hydroxy acids (AHAs) and enzymes can be used with the same regularity as microbeads.

AHAs. Lactic, glycolic, citric and malic acids, among others, are included in this category. These acids offer many ancillary benefits, including humectant qualities, inhibition of P. acnes bacteria, reduction of hyperker­atinization and an inhibition of the melanogenesis process. Some studies indicate AHA may have the ability to promote collagen deposition in addition to increasing desquamation.

Beta hydroxy acid (BHA). Salicylic acid (SA) is the only BHA currently used in skin care. It is a lipophilic keratolytic that has the ability to dissolve impactions in the follicles, reducing the occurrence of acne breakouts. Due to its anti-inflammatory benefits, SA is also a good choice for sensitive skin conditions, higher Fitzpatrick skin types I-VI and rosacea. It can be safely used in combined modality protocols.

Retinoids. All forms of vitamin A are included in this category, with retinoic acid, retinaldehyde and retinol being the most commonly used in professional treatment products. For use at home, retinol products used at night can have a dramatic effect in normalizing cell turnover and improving overall skin health. Because retinol is notoriously unstable in formulations, this beneficial ingredient is best used in a well-formulated nighttime treatment product, not a scrub. In general, retinoids help increase cellular turnover, smooth uneven skin texture, boost collagen production and improve skin discolor­ation.

Enzymes. Enzymes are catalyst proteins that start or accelerate an action. Fruit-derived enzymes such as papain from papaya and bromelain from pineapple are used most often in skin care. Enzymes are able to digest the keratin filled corneocyte, revealing the healthy cells below while living cells are left unaffected. These are also typically gentle at low percentages. You can find enzymes in many topical products and home-use treatments.

We Won’t Miss Microbeads

Our environment will thank us for getting rid of microbeads. Whether using alternative mechanical exfoliation materials or opting to use gentle chemical options—or even a combination of both—there are strategies to have skin turning over at a healthy rate and appear glowing, smooth and healthy.

Danae Markland, L.E., CMLT, has been a licensed esthetician for 14 years. She currently serves as vice president of business development for PCA SKIN and is an advanced educator.

Apply sunscreen every day. A quality sunscreen is an important element to any skin care routine. Applying it before going outside can slow down skin aging and help to prevent skin cancer. Broad-spectrum sunscreens of SPF 30 or higher and waterproof are best.

Don’t smoke. Smoking speeds up how quickly the skin ages. Additionally, research shows that smoking worsens some skin diseases, such as psoriasis and hidradenitis suppurativa, according to the AAD.

Check your skin for skin cancer. Because estheticians get an up-close view of their clients’ skin on a regular basis, they often spot potential skin cancer before their clients. Knowing the signs of skin cancer and advising at-home skin self-exams can help clients find skin cancer early when it’s highly treatable. If you notice a spot that differs from the others, or one that changes, itches or bleeds, an appointment to see a dermatologist may be in order.

Avoid tanning beds. The AAD recommends using self-tanner in lieu of tanning indoors or outside. A self-tanner can give you the look of tanned skin without the risk of skin cancer.

Use skin care products that match your skin’s needs. Using products formulated for specific needs will help it look and feel its best.

Resist the urge to scrub your skin clean. Scrubbing too vigorously can irritate the skin, which can worsen any skin condition, including acne.

Wash your face when waking, before bed and after sweating. These are the three most important times to wash your face, according to the AAD. It’s important to remove the dirt and bacteria that settle on the face while sleeping, and it’s equally as important to wash before bedtime to remove makeup and grime, such as sweat, smog, smoke or dirt, which may have landed on your skin during the day.

Gently wash your face. It may seem like a simple step, but this is an important tool in keeping the skin looking its best. First, wet the skin with lukewarm water. Then apply a mild cleanser in a circular motion with your fingertips. Finish by completely rinsing off the cleanser and gently patting the face dry with a clean towel.

Stress less. Some skin diseases often appear for the first time when someone feels really stressed. Stress can also cause flare-ups of many skin conditions, including acne, eczema, psoriasis and rosacea, according to the AAD.

See a dermatol­ogist. For a medical diagnosis or treatment outside the scope of an esthetician’s practice, it’s always best to see a dermatol­ogist.

Have you ever broken out in red rashy pimples within a few days or weeks after using a new product and thought it was acne? Many who start using topical cosmeceutical or prescription products can have this experience and use acne products in an attempt to dry the breakouts only to discover that it makes their skin worse. This is because those “pimples” are not acne. What is happening is actually a compromised or disrupted skin barrier issue because the new product is too strong for your skin at the time.

The solution in this situation is counterintuitive because instead of using an acne spot treatment, you will need a barrier cream to help your skin recover. Once the skin returns to normal, within a few days, you can reintroduce the product again slowly over the course of a few weeks until it can be used again regularly without a reaction.

A side effect of using corrective products with high concentrations of active ingredients, vitamin A derivatives like retinol or tretinoin (Retin-A), and AHAs, is called retinoid dermatitis, retinoid irritation, retinoid reaction, or AHA reaction. This “dermatitis” can usually be characterized by redness, scaling, dryness, or itching; however rash-like pustules or swollen red “underground pimples” are also very common.

Corrective cosmeceutical and prescription products induce changes in the epidermis that lead to increased and altered cell turnover. This means that the top protective layer of the epidermis is being shed faster than new cells are forming in the lower layers. This causes the skin barrier function to become “disrupted” and the compromised barrier can no longer adequately protect the cells underneath so the skin REACTS. The level of irritation reaction correlates with the potency of the applied product but there is a solution.

Recognize – a sudden appearance of pustular pimples. Immediately STOP using the product

Reintroduce – start using the product again gradually. Apply every other day for first two weeks and then daily. Experiment with smaller doses. You can cut strength by mixing with a plain moisturizer. Find your ideal dose. Maybe you can only use the product 2-3x week on an ongoing basis.

Adjusting the timing, dose, form, and strength of topical product can influence the reaction. However in some cases, even with repeated efforts at reintroducing the product, it may simply be too strong for your skin. But you will never know how a product will work for you until you try…

Sugar and High Glycemic Foods

Acne. Foods with high glycemic index—meaning high in refined carbohydrates such as white rice, white bread and white potatoes—can cause blood glucose levels to fluctuate. According to Ramsey Markus, associate professor of dermatology at Baylor, “As a result of the high blood sugar levels there is a cascade of hormones released that eventually stimulate the oil gland, leading to worsening of acne.”

Glycation and premature aging. In a Good Housekeeping interview with Nigma Talib, London-based naturopathic doctor, skin care professional and author of Younger Skin Starts in the Gut (Ulysses Press, 2016), Talib says not only can excess sugar in the diet wreak havoc on overall health, it can also lead to glycation.

Annette Tobia, founder of Dynamis Skin Science, explains exactly what glycation is in an article published in Skin Inc.last year: The glycation process involves protein cross-­linking, and this causes skin damage and aging. The process compromises the production of collagen, elastin and other proteins in the skin, all of which are essential to skin health and vitality.

Dairy Products

Swollen eyelids, dark circles and under eye bags. Talib says as clients get older, they lose enzymes that help properly digest lactose, which can lead to inflammation.

Wine

Although wine in moderation carries several health benefits, it can also mess with skin due to it’s high levels of sugar, pesticides and sulphites, as well as the fact that it is dehydrating, according to Talib.

Gluten

Gluten has been a hot term for a while now, and while not everyone actually has celiac disease, people may benefit from lowering the amount of gluten in their diet. Talib says gluten can cause blemishes on the forehead, bloated face, redness and darkened skin patches on the chin.

Birth control pills, IUDs, implants and shots are widely used today and prescribed often as a means to control acne. Most forms of birth control can have the potential to cause acne and weight gain in those susceptible. Typically birth control is divided up as estrogen or progestin dominant and have varying degrees of androgenic (testosterone like) effects. Generally, those with the potential for higher androgenic symptoms should be avoided for people prone to acne because they promote breakouts.

The most commonly prescribed in this category are:

Brevicon

Demulan

Femcon

Kelnor

Modicon

MonoNessa

Necon

Ortho Tricyclen

Ortho-Novum

Ovcon

Previferm

Sprintec

Tri-Nessa

Tri-Previferm

Tri-Sprintec

Zovia

It is best to avoid the following that are high in androgen activity and low in estrogen:

Alesse

Amethyst

Apri

Azurette

Caziant

Cryselle

Cyclessa

Depo-Provera

Desogen

Emoquette

Estrostep Fe

Implanon

Jolessa

Kariva

Lessina

Levora/Levonest

Linessa

Lo-Feminol

Lo-Ogestrel

Lo-Ovral

Loestrin

Lutera

Marvelon

Microgestin

Mircette

Mirena IUD

Nexplanon

Nordette

Norplant

NuvaRing

Ogestrel

Ortho Tricyclen Lo

Ovral

Paragard/Copper IUD*

Portia

Reclipsen

Seasonale/Seasonique

Skylar IUD

Sronyx

Triphasil/Trivora

Only you and your doctor can determine what form of birth control is right for you. The above is just a basic guideline that should be used to initiate a conversation between you and your physician. If you are considering using birth control, it is important to know that it can be associated with a high risk of blood clots, weight gain, nausea, mood changes, depression and breast tenderness. Serious side effects include strokes, digestive issues and embolism.

It is entirely possible to treat acne without using birth control. If you have no underlying health issues that require you to be on birth control and are considering using birth control only to control your acne, please consult with your doctor about selecting a form of birth control that is higher in estrogen and lower in androgen potency.

*Although the Paragard/Copper IUD does not contain any hormones, we have observed that it has aggravated acne with our clients.